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The Nightmare of Medication Prior Authorizations

Posted on February 11, 2015

With the start of the New Year many insurance plans may have changed some of your health plan benefits, policy number, group number or prescription plan benefits. You may have received a notice, new cards or even a formulary from your insurance company. If you are like my spouse, you may have thought that the cards were the same and put them away; you may have thrown out the formulary wondering why they sent it to you in the first place. The next thing you know, you are going to pick up your prescription and find out that the medication now requires a prior authorization and here you are running out of your medication. This is where the nightmare begins!

Prior Authorization Problems

We have encountered many issues with prior authorization requests including not having updated insurance information. To help avoid delays, when you get a new card from your insurance company, it is best practice to change out the old with the new. This is one of the steps you can take to be proactive in helping us to get your medications approved by your insurance company. Some insurance companies have the prescription benefit information on one card, some send out a separate prescription plan card. If you are one with separate cards, make sure that you provide both benefit cards to your physician’s office.

When you go to fill your prescription and the benefit information is processed by the pharmacy, they get a notification that some medications require approval from your insurance company. They fax a form to your physician office to initiate the request. Most requests are handled in our office within 1 week. Once we send in the information, we wait to hear back from your insurance company for the approval or denial.

How can Patient Portal help?

If you are a current patient portal user, you can get up to date information sent to you once the initiation process has been completed. If it has been over a week and you still have not heard anything, you can be proactive and contact your insurance company for a status update. Sometimes this can make the process a little bit quicker. Once we have received notification of the approval or denial, we have the ability send you a courtesy notification of the insurance decision.

If you are not a patient portal user, you are missing out on a lot of great features! Did you know that you can:

receive courtesy notifications if you called and left us a voicemail message

receive status updates on your medication prior authorizations

submit blood pressure and blood sugar levels

We at Wake Internal Medicine Consultants understand that your time is valuable and with the updates in technology many prefer to use our secure patient portal. We also understand that some of you may have reservations about using the portal or might be having issues logging in for the first time.You can view the How To Video on our main website or you can go directly to YouTube! Here is the link to the video: